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Diagnostic role of echocardiography for patients with heart failure symptoms and preserved left ventricular ejection fraction

Rolle der Echokardiographie in der Diagnostik bei Patienten mit Herzinsuffizienzsymptomen und erhaltener linksventrikulärer Ejektionsfraktion

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Abstract

The syndrome heart failure with preserved ejection fraction (HFpEF) represents patients with different comorbidities and specific etiologies, but with a key and common alteration: an elevation in left ventricular (LV) filling pressure or pulmonary capillary wedge pressure (PCWP). Expert consensuses, society guidelines, and diagnostic scores have been stated to diagnose HFpEF syndrome based mainly on the determination of elevated LV filling pressure or PCWP by transthoracic echocardiography (TTE). Echocardiographic parameters such as early (E) and late diastolic mitral inflow velocity (mitral E/A ratio), septal and lateral mitral annular early diastolic velocity (E′), ratio of the early diastolic mitral inflow and annular velocity (E/E′-ratio), maximal left atrial volume index (LAVImax), and tricuspid regurgitation peak velocity (VTR) constitute the pivotal parameters for determining elevated LV filling pressure or PCWP in patients with suspected HFpEF symptoms. Notwithstanding this, taking into consideration the heterogeneity of patients with HFpEF symptoms, the term “HFpEF” should be considered as a syndrome rather than an entity since HFpEF results from different pathological entities that should and can be characterized by echocardiography and multimodality imaging. Comprehensive TTE might help diagnose specific diseases and etiologies by characterization of specific cardiac phenotypes.

Zusammenfassung

Das Syndrom der Herzinsuffizienz mit erhaltener Ejektionsfraktion („heart failure with preserved ejection fraction“, HFpEF) steht für Patienten mit verschiedenen Komorbiditäten und spezifischen Grunderkrankungen, die jedoch eine gemeinsame charakterisierende Veränderung zeigen, nämlich den pathologischen Anstieg der linksventrikulären (LV-)Füllungsdrücke oder des pulmonalkapillären Wedge-Drucks (PCWP). Expert Consensus Statements, nationale und internationale Leitlinien sowie Diagnose-Scores wurden publiziert, um das HFpEF-Syndrom zu diagnostizieren, vornehmlich basierend auf der Bestimmung eines erhöhten LV-Füllungsdrucks oder PCWP mittels transthorakaler Echokardiographie (TTE). Die echokardiographischen Parameter der frühen (E) und späten (A) diastolischen transmitralen Flussgeschwindigkeit sowie deren E/A-Ratio, die septale und laterale mitralringnahe Myokardgeschwindigkeit (E′), das Verhältnis der frühen transmitralen Flussgeschwindigkeit zur mitralringnahen Myokardgeschwindigkeit (E/E′-ratio), der maximale linksatriale Volumenindex (LAVImax) und die maximale transtrikuspidale Regurgitationsgeschwindigkeit (VTR) bilden die grundlegenden Pfeiler, um einen erhöhten LV-Füllungsdruck oder PCWP bei Patienten mit HFpEF-Symptomen festzustellen. Nichtsdestotrotz sollte in Anbetracht der Heterogenität der Patienten mit HFpEF-Symptomen die Bezeichnung „HFpEF“ immer als Syndrom anstelle einer Diagnose betrachtet werden, da HFpEF durch verschiedene pathologische Gegebenheiten begründet sein kann, die durch Echokardiographie und weitere multimodale Bildgebung detektiert werden können und sollten. Eine fachkundige TTE kann über die exakte Charakterisierung von echokardiographischen Phänotypen zur Diagnose spezifischer Erkrankungen und Ätiologien beitragen.

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Funding

Research of Carsten Tschöpe was funded by the Deutsche Forschungsgemeinschaft (DFG, German Research Foundation)—SFB 1470, project: B02. Research of Rudolf A. de Boer was funded by the Netherlands Heart Foundation (CVON grants 2017-21; 2017-11; 2018-30; 2020B005) and the European Research Council (ERC CoG 818715). For all other authors this research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

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Authors and Affiliations

  1. Department of Cardiology, University of Leipzig, Liebigstr. 20, 04103, Leipzig, Germany

    A. Hagendorff, S. Stöbe & J. Kandels

  2. Department of Cardiology, University Medical Center Groningen, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands

    R. de Boer

  3. Institute of Health at Charité (BIH), Center for Regenerative Therapies (BCRT), Universitätsmedizin Berlin, Berlin, Germany

    C. Tschöpe

  4. Partner Site Berlin, German Centre for Cardiovascular Research DZHK, Berlin, Germany

    C. Tschöpe

  5. Department of Cardiology, Charité University Medicine Berlin, Campus Virchow Klinikum, Augustenburger Platz 1, 13353, Berlin, Germany

    C. Tschöpe

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  1. A. Hagendorff
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Correspondence to A. Hagendorff.

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A. Hagendorff, S. Stöbe, J. Kandels, R. de Boer and C. Tschöpe declare that they have no competing interests.

For this article no studies with human participants or animals were performed by any of the authors. All studies mentioned were in accordance with the ethical standards indicated in each case.

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Hagendorff, A., Stöbe, S., Kandels, J. et al. Diagnostic role of echocardiography for patients with heart failure symptoms and preserved left ventricular ejection fraction. Herz 47, 293–300 (2022). https://doi.org/10.1007/s00059-022-05118-6

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